The loss of eye closure and blinking is one of the most significant problems associated with Bell's palsy and facial paralysis. Disruption of this protective mechanism can lead to irritation of the eye (conjunctivitis), ulceration of the cornea (exposure keratitis) and blindness. Lubrication of the eye is initially achieved with artificial tears, lubricants and taping the eye closed at night. If the ability to close one's eye does not return, a more permanent solution is required. Eye closure and blink can be reestablished utilizing an implantable gold weight in the upper eyelid.

Fortunately, one's ability to open the eye is not controlled by the facial nerve and usually remains unaffected by most causes of facial paralysis. The functioning eyelid elevation mechanism opens the eye allowing the implanted weight to close the eye passively utilizing the force of gravity. 

This combination of active opening and gravitational closure can be very effective in simulating normal eyelid function.

Technique

The procedure is initiated by selecting the proper size weight. In the clinic a series of weights are secured to the upper eyelid with two-sided tape to help determine the optimal size. The weight that produces rapid eye closure without the look or sensation of eyelid drooping (lagopthalmus) is selected. 

If the individual is uncertain about the benefit of the eye lid weight then external weights are available to “test-drive” for a several week period.

The eyelid surgery is performed under general anesthesia. Through a limited incision in the crease of the upper eye lid, the pre-selected gold weight is implanted beneath the skin and secured into position above the eyelashes.